The purpose of the study is to investigate the effect of adding Bruegger's exercises on conventional exercise program in treatment of forward head posture.
Forward head posture, head-on-trunk misalignment, leads to increased lordosis of the lower cervical spine as well as rounded shoulders accompanied by increased kyphosis of the thoracic spine. These musculoskeletal disorders change the balance of the muscles around the neck. Bruegger's postural relief position is one such self-care exercise that works in order to reverse Forward head posture (FHP) by strengthening the scapular retractors meanwhile stretching the protractors. This exercise helps in aligning the spine in correct position through isometric co-contraction of scapular muscles, thereby improving scapular stabilization. The exercise helped in strengthening the weak deep cervical flexor muscles since it includes isometric contraction of neck muscles through chin tuck. Although Bruegger's exercises has been widely suggested or advised clinically by the physiotherapists, there is a lack of research-based evidence/data which proves regarding its effect in the correction of FHP. Hence, it was hypothesized that the Bruegger's exercises will show favorable results in the correction of FHP and craniovertebral angle (CVA). This study may benefit physical therapists by providing a new and easy approach in treating FHP.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
24
The participants will be treated with conventional core stability exercise; Neck Stability Exercises-Free exercise for cervical spine, Neck isometric exercises (flexion, extension, lateral flexion, rotation), Wall angle exercises for lower trapezius, Chin tuck, Chin tuck into the towel
Bruegger's Position of external arm rotation, shoulder abduction and retraction of the scapulae . This position with simultaneous head and neck retraction is a strengthening exercise for deep neck flexors and lower scapular stabilizers. The subjects are instructed to place their feet on the floor completely and keep their knee joints 10 ㎝ below the hip joints in 45° of abduction. The subjects sit hitting their ischial tuberosity on the chair and maintained their physiological curvature for the TL spine. Following external rotation of the glenohumeral joints, tension is relaxed with each inhalation, and depression and retraction of the shoulder girdle are performed with each exhalation.
Hadeer SalahEldin Mahmoud
Cairo, Egypt
Assessment of pain intensity
The numerical pain rating scale will be used to assess pain intensity. It is 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable.
Time frame: 4 weeks
Assessment of craniocervical angle (CVA)
The CVA will be evaluated with forward head posture (FHP) application on a Xiaomi® MiA2. Two markers are placed on the ground separated by 1.5 m, where the camera or smart phone and the subject are located. Reference markers are placed on the spinous process of C7 and in the swallow of the subjects' ears, which were identified through palpation. The subject is placed on the floor mark, barefoot and standing, lateral to the evaluator. The application provides the complement to the CVA, thus making further calculation necessary. To determine the CVA, it is necessary to subtract the angle provided by the application from 360°. The presence of FHP will be determined by an angle value lower than 50°, and the absence of FHP if the angle value is greater than or equal to 50°
Time frame: 4 weeks
Assessment of craniocervical flexion endurance
Craniocervical flexion endurance test (CCFE test) will be used. The position of the participant is supine with cervical spine in the neutral position. The PBU is placed between the plinth and the posterior neck just below the occiput. The cuff is then inflated to a baseline of 20 mmHg. The participant was then asked to avoid head lift during CCFE test, thereby reducing the recruitment of superficial flexors. Each participant will be asked to perform the neck flexion movement at five different pressure levels (22, 24, 26, 28, and 30 mmHg) with 10 s hold at each level and 30 s rest between each level. The test is terminated if the subject is not able to hold the position of the neck for 10 s at a specific pressure level or if the maximum level of 30 mmHg is achieved.
Time frame: 4 weeks
Assessment of function disability
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Arabic version of neck disability index will be used to assess function disability. Questions include activities of daily living, such as personal care, lifting, reading, work, driving, sleeping, recreational activities, pain intensity, concentration, and headache. Each question is measured on a scale from 0(no disability) to 5, and an overall score out of 100 is calculated by adding each item score together and multiply in it by two. A higher NDI score means the greater a patient's perceived disability due to neck pain.
Time frame: 4 weeks